Insurance & Coverage
Coverage explained in plain language.
Understand Medicare DME, Medicaid, private insurance, prior authorization, and appeals.
Guides & articles
Voices Unheard: Barriers to Expressing Dissatisfaction to Health Plans - PMC
It can be hard for people to complain to their health insurance company when they're unhappy with their care. This is because health issues can be complicated, and it's not always clear who is at fault. Also, being sick can make you too tired or overwhelmed to deal with the hassle of complaining. Even though laws have been put in place to help people voice their concerns, many still don't, or they find it hard to get their problems fixed.
Source: National Library of Medicine
Patient-initiated electronic health record amendment requests - PMC
Patients can ask to change their electronic health records if they find mistakes. This process is called an "amendment request." A study found that most requests were to fix wrong information, and about half of these requests were approved. Very few patients actually ask for changes, possibly because they don't know they can or how to do it. Making it easier for patients to see and change their records could help make medical information more accurate, but it's important to do this carefully.
Source: National Library of Medicine
Informing Patients: A Guide for Providing Patient Health Information - PMC
This article discusses how giving patients printed summaries after their doctor's visits can help them understand their health better. Patients in a study said they wanted more information about their health and treatment, especially after leaving the clinic. They felt that getting a printed summary, which included their personal health data and educational information, made them trust their doctors more and motivated them to follow their treatment plans. The study suggests that providing clear, concise, and personalized health information can greatly improve a patient's experience and their involvement in their own care.
Source: National Library of Medicine
Medigap-guaranteed issue associated with Medicare Advantage disenrollment for beneficiaries administered a part B drug - PMC
This study looked at how often people with Medicare Advantage (MA) switch back to regular Medicare, especially those who need expensive, doctor-administered drugs. They found that people in states where it's easier and more affordable to get Medigap insurance (which helps cover costs not paid by regular Medicare) were more likely to leave MA. This suggests that when Medigap is a good option, people with high medical costs, like those needing pricey drugs, prefer to switch to regular Medicare to get better coverage for those expenses.
Source: National Library of Medicine
Medicare Beneficiary Satisfaction with Durable Medical Equipment Suppliers - PMC
This article looks at how happy Medicare patients are with companies that provide medical equipment like wheelchairs or oxygen tanks. The study found that most patients are very satisfied with these companies, especially when equipment is delivered quickly, training is provided, and the service is dependable and frequent. This information is important because Medicare is trying to lower costs for this equipment, and the study helps understand if these changes might affect how happy patients are with their service.
Source: National Library of Medicine
Coverage of Assistive Technologies and Personal Assistive Services - The Future of Disability in America - NCBI Bookshelf
Getting insurance to cover assistive technology, like wheelchairs, or personal care services can be a real headache for people with disabilities. Even with help from doctors, it's often a long and frustrating fight to get approval, and success isn't guaranteed. Many insurance rules, especially around what's considered "medically necessary," haven't caught up to truly support people living independently. This means people might be denied things that would greatly improve their daily lives, forcing them to pay out of pocket or go without.
Source: National Library of Medicine